Thanks to Catherine Thatcher and Julie Brown, teaching fellows at Sunderland Royal for this scenario

Emma Morrison is a 72 year old lady admitted with severe back and hip pain. She has been feeling generally unwell for 2 months and has a history of ovarian cancer for which she had surgery and follow up chemotherapy 2 years ago.

She has been diagnosed with bony metastases and a DNAR form has been completed.

She is currently prescribed 5 mg of morphine subcutaneous PRN which she has needed every 2-3 hours for the past 24 hours. She has had 60mg in total over 24 hours. Her weight is 52kg. Emma is nil by mouth as she is no longer able to swallow.

This morning the nursing staff reported that Emma is crying in pain when being moved. She is agitated, restless and distressed.

You have been asked to prescribe a subcutaneous infusion for Emma:

Please convert her morphine and anti-emetics to a syringe driver and add something for agitation

Would you want to prescribe anything else as well as the syringe driver? If so prescribe them on a standard drug chart.

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